Authors Offer Recommendations on How to Address Health Inequities

Today, CareQuest Institute for Oral Health®, the Society of American Indian Dentists (SAID), and the National Indian Health Board’s (NIHB) Tribal Oral Health Initiative released a white paper on oral health disparities in American Indian and Alaska Native (AI/AN) communities.

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The white paper, “American Indian and Alaska Native Communities Face a ‘Disproportionate Burden of Oral Disease’: Reversing Inequities Involves Challenges and Opportunities,” includes striking new data from CareQuest Institute’s State of Oral Health Equity in America survey and offers strategic recommendations on how to address disparities and inequities facing AI/AN communities.

Filled with graphics, quotes, and frameworks, the paper details how historical and intergenerational trauma including genocide, exposure to infectious diseases, forced boarding school attendance, lack of access to nutritional and affordable food, and lack of access to routine preventive care place AI/AN communities at high risk of poor overall and oral health outcomes.

“The data and research in this white paper affirm the serious health disparities that AI/AN communities have faced for generations due to structural racism and historical trauma,” said CareQuest Institute CEO and President Myechia Minter-Jordan, MD, MBA. “We need broad distributive justice to break this cycle. Our hope is that the data and recommendations in this white paper help address the deep health inequities facing this population. We are grateful to SAID and NIHB for their partnership on this important project and look forward to continuing to work with all stakeholders toward solutions.”

"SAID is committed to achieving equal representation for AI/ANs in the field of dentistry and we are grateful for the opportunity to partner with CareQuest Institute to contribute to the understanding of oral disease as it impacts our communities and people,” said Cristin Haase, DMD, MPH, president of Society of American Indian Dentists. “Partnerships such as these are important for opening the door to critical conversations and driving change towards inclusive oral health care for AI/AN communities. It is common for our population to be excluded or erased from data collection regarding dentistry workforce and oral health, and it is vital that we continue to remain visible and raise awareness of the issues."

Findings from the white paper include:

• The prevalence of early childhood caries (tooth decay) in AI/AN communities is three times higher than it is for white children.
• AI/AN adults are twice as likely to have untreated decay as the overall US population, and 83% of AI/AN adults report tooth loss compared to 66% of the overall US population.
• Three and a half times as many people who identified as AI/AN reported going to the emergency department for dental care or mouth pain in the last year (13.5%) compared with those who do not identify as AI/AN (3.9%).
• More than half of AI/AN adults (54.1%) reported being denied health care or oral health care at some point due to discrimination, compared to 40% of non-AI/AN respondents.
• The number of AI/AN students applying to dental school has decreased dramatically over the past decade, with a record high of 92 in 2006 to record lows within the past 20 years of 16 AI/AN applicants in 2019 and only eight in 2021.

The authors also make several strategic recommendations on how to reduce oral health disparities in AI/AN communities, including:

• Developing partnerships with AI/AN communities and organizations to better understand their priorities.
• Collecting more accurate data, including the inclusion of AI/AN as an individual category to avoid misclassification.
• Increasing representation of AI/AN individuals in dental education settings.
• Developing career pathway programs for AI/AN individuals to enter all dental workforce positions.
• Ensuring state and federal oral health care policies are made in collaboration and consultation with tribal leaders and the Indian Health Service.

Read the full white paper here.

CareQuest Institute is hosting a webinar, in collaboration with native-led organizations, to discuss the findings and recommendations from the white paper on Thursday, March 30 at 1 p.m. ET. A panel of experts will detail the disparities facing AI/AN populations and share ongoing culturally and community-driven strategies to improve AI/AN oral health. Register here.

About CareQuest Institute for Oral Health®

CareQuest Institute for Oral Health® is a national nonprofit championing a more equitable future where every person can reach their full potential through excellent health. We do this through our work in grantmaking, research, health improvement programs, policy and advocacy, and education as well as our leadership in dental benefits and innovation advancements. We collaborate with thought leaders, health care providers, patients, and local, state, and federal stakeholders, to accelerate oral health care transformation and create a system designed for everyone. To learn more, visit carequest.org and follow us on Twitter, LinkedIn, Facebook, and Instagram.

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